MEDICARE: MEDICAID TRAVEL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	343900000X	Non-emergency Medical Transport (VAN)
3	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1528607207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAID TRAVEL, INC.

Provider Business Mailing Address
First Line	:	615 SAINT GEORGE SQUARE CT STE 300
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1368
Country	:	US
Telephone Number	:	919-737-0734
Fax Number	:	216-250-8369

Provider Business Practice Location Address
First Line	:	615 SAINT GEORGE SQUARE CT STE 300
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1368
Country	:	US
Telephone Number	:	919-737-0734
Fax Number	:	216-250-8369

Authorized Official
Title or Position	:	CEO
Name	:	MR. DYLAN MACK CARDEN
Credential	:
Telephone Number	:	919-737-0734

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	06/25/2020

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Directions to “MEDICAID TRAVEL, INC. ” Practice Location

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